Tuesday, 12 December 2017

MOOC ‘Understanding Violence against Women – Myths and Realities’

As acronyms go MOOC doesn’t roll easily off the tongue. Massive Open Online Courses harness the reach of the worldwide web to the immediacy of social media and magically turn teaching and learning into something entirely new for educators and learners alike. Developing a new MOOC ‘Understanding Violence against Women – Myths and Realities’ with my colleague Roisin McGoldrick took us into uncharted technological and pedagogical waters. With no students in front of you and no entry requirements, these free courses, covering every subject under the sun, attract learners from across the globe who might be studying at all hours of the Scottish day and night. Designing a course on VAW, a complex and at times controversial topic, for an invisible audience, was a challenge to two experienced educators used to the cut and thrust of lectures, PowerPoint, handouts and groupwork. Converting what we knew into audio-visual learning steps to capture and retain learners’ interest over a six-week period meant that most of how we did things went out the window. Knowing you are only ever one click away from internet oblivion at the best of times, teaching such a complex and highly controversial a subject required us each to find a friendly yet authoritative ‘voice’, somewhere between a pal and a mentor. I won’t even go into the whole teaching to camera business...

My long experience of teaching about violence against women has shown me that it is one of the few academic subjects where students’ personal opinions can sometimes trump all the research evidence you can throw at them. Violence against women (VAW) is so deeply interwoven in the warp and weft of world history and modern life that finding a way to unpack its complexities was our first task. We wanted to stimulate thinking and ideas around violence against women and girls and offer perspectives for people to consider. We were firmly feminist in our approach and were clear that our aim was not necessarily that everyone agreed but that we provided them with a strong foundation from which to build their learning and their own analyses. To do that we needed to introduce some serious sociological concepts such as gender, power and violence. We hoped this would help them make personal connections with underpinning theories, theoretical frameworks and the lived realities for women living with violence the world over.

Before we started on the content however we were clear we needed a clear ethical learning framework for learning. Given its high international prevalence and gendered nature, it was very likely that many of our participants would have either direct or indirect experience of violence against women and girls in private, social or public settings. We recognised that for some, this may well have influenced their decision to study the course and how they might interpret our materials. We would be covering topics which people would likely find distressing and because we were not around to have a private chat after class, we created a ‘Health Warning’ with regular reminders about the need for self-care and regular breaks to allow processing and learning. We established clear ground rules stressing the importance of being mindful of themselves and respectful of others in group discussions and in responding to other people’s posts in the online space, their sole and virtual classroom. WE stressed that personal experience is wholly that – unique and personal - and should not be used as evidence of more general points that people might wish to make. The chances of disclosures were likely to be high and we asked people only to share information about themselves that they were comfortable making available in the course’s public online platform. This request was well adhered to and might be a useful reminder for use in other public social media platforms,

“Please be sensitive to the potential for causing distress to yourself and to others in what you say and post during your time studying on this course.

We observed this in action many times. Participants contravening the ground rules were dealt with very effectively and graciously by the others in ways which were a model of pro-social, measured and well-argued rebuttals.

Each learning step of the six-week course contained short lectures, reading materials, hyperlinks, video extracts and opportunities for online discussion. There were quizzes and ‘live streams’ where people could tune into a YouTube channel and post question for us to answer live on air. We eventually got used to teaching direct to camera, to breaking learning down to small baby steps and getting to the point and sharpish! We dashed off compact articles, wandered down the vast storehouses of Shutterstock images, interviewed experts over Skype and chipped into online discussions being carried out across continents. We learned about media schedules, subtitling, editing and were fortunate in having tremendous contributions from a range of well-kent Scottish and internationally renowned experts in the VAW field and the support of a team of learning technologists and film and audio-visual specialists.

Our community of learners included survivors, a range of professionals, VAW specialists, students and people who were simply interested in exploring a new subject. Some were regular contributors to the discussion and many were not – content to learn in their own way. There is absolutely no requirement to chip in our ‘tuppenceworth’. We witnessed extraordinary moments of enlightenment as people began to make sense of their own or others’ experiences. We read with interest as people spoke of their growing confidence in their own knowledge to open up conversations about VAW with family, friends and colleagues for the first time. In an extraordinary piece of sychronicity, the Weinstein story and the #MeToo campaign broke when we were dealing with ‘Media Representations of VAW’. The chat was mighty and the analysis of the press coverage was a joy to behold in its confidence, knowledge and outrage! The pleasure of taking part in discussions with participants from every corner of the globe, of hearing their perspectives and of reaching so many people was a new one to me. The feedback since the first course ended in mid-November 2017 has been extremely positive. People connected to the issue in new ways, realised that they could play a part in preventing violence against women and many resolved at the end to take action in their own communities. The course page invites learners to join the global movement to prevent VAW. By taking part in a course like ours I believe they made a start. We explored VAW Prevention at the end of the course and when people read about the first Zero Tolerance Campaign in Scotland, the 16 Days of International Activism against VAW, One Billion Rising and White Ribbon for instance many were inspired into taking action in their own communities. Learning about VAW is an intervention and a key part of primary prevention. Knowledge is indeed power, we busted some myths and shared some realities and just maybe we have helped bring about some changes of mind. People are already signing up for the next run starting on 5 February 2018. Click here to join us.

Anni Donaldson
I am a Knowledge Exchange Fellow and Project Lead at the Equally Safe in Higher Education (ESHE) Project at the University of Strathclyde. Based in the School of Social Work and Social Policy, the ESHE Team are creating a national Gender-based Violence Prevention toolkit for use in Scottish universities. I have been working in the field of domestic abuse and violence against women research, teaching and practice development for nearly thirty years. I am a historian and am currently completing my doctoral thesis ‘An oral history of domestic abuse in Scotland 1979-1992’. I am also a blogger and journalist.

anni.donaldson@strath.ac.uk

@AnniDonaldson

Blog: www.glasgowanni.com

@equallysafeHE

#16daysStrath

#Emilytest








Sunday, 10 December 2017

VAW 2017: Issues of Economic Safety and Economic Abuse in British South Asian Households: Reflections from an ESRC Festival of Social Science Event

by Punita Chowbey, Sheffield Hallam University
and Nicola Sharp-Jeffs, Surviving Economic Abuse Charity 

Findings from a recent study (Chowbey 2017) from Sheffield Hallam University focussing on South Asian women from diverse socioeconomic and migration backgrounds revealed that there is little awareness of the issue of economic abuse. Of 84 women interviewed, 33 reported some form of economic abuse. Although many women did not recognise economic abuse as a form of 'abuse', several were fighting it in their own ways. In their fight they faced substantial barriers, such as a lack of resources, access to legal guidance and family pressure, which prevented them from seeking support.

To support South Asian women suffering from economic abuse, there is a need to understand the economic risks that threaten their economic safety on two levels. First, while anyone can experience economic hardship, systems of discrimination mean that not everyone has the same opportunities to access economic resources (money, housing, transportation, mobile phone etc.). For instance, barriers still exist which stop many women from being economically independent. The gender pay gap means that many women are paid less than men and because of their caring responsibilities they are less likely to be working, or working in part–time and low-paid work. Other risks here may be linked to other identifiers such as age, ethnicity, ability, sexual orientation and citizenship status. Welfare benefits act as a safety net so that if a woman is experiencing abuse from her partner then she is able to leave and have an income. Yet the immigration status of some women means that they are unable to claim benefits, meaning they have fewer options to choose from when they try to find a place of safety.


The second type of risk occurs when an individual seeks to control over a woman’s current and future economic choices. This may be a partner or a family member. The gender discrimination which exists in society may be reflected in women’s own households: for example, men may expect to be in charge of economic resources; men may expect women to stay at home and look after the family rather than go out to work; and more economic resources may be allocated to sons than daughters. In some cases, this behaviour may be deliberate. A man may choose to control a woman’s access to economic resources to stop her from making her own choices. If a partner is abusive, he may threaten to throw her out of the house if she does not do what he says. He may prevent her from eating food or turning on the heating if she challenges a decision he has made. He may stop her from going to work and having access to money, a mobile phone or a car in order to stop her from getting help or leaving.

To engage with the community members on this subject, Sheffield Hallam University held an ESRC Festival of Social Science event on the 8th of November in Sheffield in partnership with Firvale Community Hub, formerly Pakistan Community and Advice Centre.. The event engaged members of the local community, women from South Asian background and academics and practitioners. The participants concurred with the research findings and suggested several issues as key to ending economic abuse. Their suggestions considered how economic abuse can be prevented and how those experiencing it can be supported: 
  • Parenting emerged as one of the key areas needing attention. Several participants identified the roots for economic abuse in parenting practices in South Asian families which promote gender roles that encourage economic independence for sons and housekeeping skills for daughters.
  • Participants said that parents saw sons and daughters having different economic needs. Whilst economic responsibilities towards sons are often realised through education and investment in making them financially independent, economic responsibilities towards girls involves saving for their dowry and marriage. Participants felt that this way of thinking is a big barrier in making women economically independent. 
  • Education and awareness of economic rights including inheritance rights came up as a major issue. Participants felt that there is little knowledge of economic rights among South Asian women. Several of them pointed out that women are expected to follow the inheritance rights and practices of South Asia and they knew very little about their economic rights in Britain.
  • Participants also identified the need for communities to look within themselves. Sociocultural norms can make it difficult for women to speak up and seek support. 
Finally, women should be adequately supported in reaching out to services for help to become economically stable. This may mean getting support to find employment and access benefits or tailored support if their age, sexuality, ability, ethnicity or immigration status means they have particular needs or concerns. 


Reference

Chowbey, P. (2017). Women’s narratives of economic abuse and financial strategies in Britain and South Asia. Psychology of Violence, 7(3), 459-468.



Music can help biopsy patients

Roger Watson, Editor-in-Chief

A biospy is an invasive procedure and one which may lead to an unwelcome diagnosis. Clearly, the whole experience can be stressful for patients and, it seems, music may be helpful. This is the conclusion of a study from China by Song et al. (2017) which aimed to 'evaluate the efficacy of music therapy for reducing the anxiety and pain of patients who underwent a biopsy'. An article published in JAN from the study is titled: 'Music for reducing the anxiety and pain of patients undergoing a biopsy: a meta-analysis'. 

Nine studies were found involving over 300 patients and the results showed that: 'Music had a
tendency towards decreasing systolic blood pressure before the biopsy' and 'music also tended to be more effective for controlling pain after the biopsy'. On the basis of their findings, the authors concluded: 'The results of the meta-analysis of nine relatively small studies indicate that music intervention is an effective aid for reducing pain in patients after a biopsy. Limited to the small number and low quality of included studies, this could not be considered a conclusive statement. However, as one of the most commonly used self-help strategies, music is suitable for relieving pain during invasive procedures. We still recommend that an intervention with soft, soothing and melodious melody should be accepted by patients from arrival at the biopsy operation room up to the end of the procedure. Without any reports of adverse effects, nurses can use our findings in their practice to promote the recovery of patients after a biopsy.

You can listen to this as a podcast

Reference

Song, M., Li, N., Zhang, X., Shang, Y., Yan, L., Chu, J., Sun, R. and Xu, Y. (2017), Music for reducing the anxiety and pain of patients undergoing a biopsy: a meta-analysis. J Adv Nurs. doi:10.1111/jan.13509

Saturday, 9 December 2017

VAW17: Happy Ever After? My Abusive Marriage; Insights from the Front Line

by Laura

Abusive relationships aren’t abusive all the time. If they were, maybe they wouldn’t last so long. Abusive incidents occur alongside the fabulous times that all families have. Low level abuse permeates day to day life and is accepted as normality. Perceptions of what is acceptable or safe are skewed. Each time something awful happens, it’s followed by a period of ‘loving’ behaviour. Many people experiencing abuse don’t actually recognise that they are being abused until later. So that means it’s desperately hard for professionals to recognise it and to intervene appropriately.

Through this blog, I aim to share my experiences of abuse with the hope that my reflections and insight will be helpful to any health care professional, and may help them recognise signs of abuse and control in relationship.

Thankfully practice across health and social care, and the police and criminal justice services has improved considerably since my experience. I’ve worked in this area for the last 15 years. There is much more public awareness today too. But it still boils down to individual nurses, doctors, police officers and others being aware, and asking the right questions, and being prepared to intervene, offer support, take action.

As you read this, consider whether someone going through the experiences I’ve recounted here would receive a different and better response today. Would Laura and her children still live in this situation for 20 years? I have written a summary of the incident and then my reflection about the experience to highlight what could be learned from it.


Summer 1979
The first violent and aggressive row occurred; we had been going out for a few months, and I had a pre-booked holiday with a friend and her mum and dad. His unfounded allegations of me sleeping around on the holiday would subsequently be raised many times over the next 20 years. 

No agency was involved here, but I think this highlights the need for young people to receive awareness sessions in school. I had no idea this was the beginning of abusive behaviour. I thought he loved me and this was driving his unreasonable behaviour.

March 1980 
Moved in together after an argument with my mum, who didn’t like him.

Sept 1980
Married – mum said “it’s not too late” as I got ready. He hit me for the first time later that day in front of my parents. They said nothing.

Again, a greater public awareness of abuse, as there is now, might have made my Dad or Mum challenge his behaviour. It was definitely as if, because I was now married, it was not their business.

May 1981
My son was born. Husband caused a row in the hospital ward and was asked to leave. Told staff I didn’t want to go home. I was in hospital for a week.

Here was the first opportunity for a health professional to take some action. His publicly aggressive behaviour towards both me and the staff should have been a definite ‘red flag’, when I add that the row was about me breastfeeding ‘in front of’ other people, including other fathers, you see his inappropriate possessive and obsessive jealousy.

What actually happened was the porters or security staff escorted him out. Nobody said anything to me about it. So this contributed to my acceptance of it once again.


June 1983
Daughter born. Serious debt problems.

I was in contact with health visitor, GP and midwife. I didn’t have the bus fare to go to the ante-natal classes, and I told the midwife this. We were in serious debt because he was in and out of work, and would spend money on cigarettes and alcohol when we had it. She didn’t question me more about finances, maybe she could have just asked if we were getting all our benefits, or asked if I wanted to talk to someone about my money worries. I was very stressed and worried all the time.
March 1984
Pregnant again despite being on minipill as was breastfeeding. Was pressured into an abortion. Kept this secret from everyone except him. Had to deliver baby as it was at 12 weeks gestation. No support, counselling or follow up. Was never spoken to alone. 

I didn’t even think of an abortion. It went completely against my values. Especially so far on. My husband just said we had to ‘get rid of it’ immediately I told him. We were interviewed by two doctors. At one point he got angry with the doctor, who was trying to dissuade us, and said ‘ok then you can look after it when it’s born’. I sat in silence throughout. I firmly believe they signed it because of him being aggressive.

1986-92
Many incidents not reported to police or any agency. Increasingly violent. He was drinking a lot. School teacher said to my daughter ‘ we know what your dad’s like’ I didn’t find this out till long after I had left him. 

This is a pattern of escalation, then an incident, then a ‘honeymoon’ period. That a teacher had picked up on his attitude through contact with him shows this spilled over sometimes into public exchanges. But for the most part he was able to control his behaviour in public.
1994
He decided he wanted to work with children, and to foster. Went through all the assessments and were accepted. Around same time he secured a job with Children’s Social Care as a Social Work Assistant. 

After years in the building trade, no qualifications and poor literacy, this seemed a tall order. He began to volunteer as a sessional worker for social care. Mainly driving children for contact visits etc. He became particularly close to one child. He wanted to foster him. So we went through the process. Always seen together. We were accepted and the young lad was placed with us. In a strange way this was a period when his behaviour improved. It lasted 6 months.

1995-2000
Increasingly bad outbursts smashing things, throwing plates, often in front of children. I had nightmares and sleep disturbances. Neighbours complained about noise. 

1996
Visited GP. He came into the consultation with me and told my GP I needed sleeping pills as he was not getting any sleep! I left with a prescription for Dothiapin, a bottle of 40 tablets was given to me. 

A very clear chance for a medical professional to intervene. He did not ask any questions, and did not ask my husband to wait outside. He focused on the practical, medical issue, lack of and disturbed sleep, and not what might be causing it. The prescription was a completely inappropriate and excessive response.

A few days later after yet another incident I took them all in one go and went to bed. He somehow knew and found the bottle hidden at the bottom of the waste bin and called ambulance. I was lucky to survive, had stomach pumped. Stayed in hospital overnight and saw a psychiatrist next day. I told psych I was sorry, didn’t mean it, and wouldn’t do it again, was happily married. He released me with no further action.

I came out of the room, and when we got outside husband accused me of having sex with the psychiatrist.

I was instructed to never mention it again, the children were in their early teens but were just told not to mention it. I never told anyone for years. This was Sunday. I returned to work Monday, and it was never mentioned again.

So many opportunities over this 24 hour period. First the ambulance crew, perhaps they took in what was happening in the house. Saw the children’s fear, I don’t know. But they didn’t say anything.

As I was having my stomach pumped I recall a male nurse talking to me and telling me I could get help. I couldn’t take it in. Offers of help need to be timely.

The next morning, I fobbed off the psychiatrist who clearly just wanted to discharge me. He never notified my GP – or if he did the GP never acted on the information. I find this shocking; it was a serious, life threatening overdose. I meant it. I returned home to the continuing abuse.



1997
Very violent incident after which I left but returned later to sort it out with him. 

After all these years, and the tacit acceptance by everyone of what was happening, I didn’t feel I had any options, but to sort it out. He convinced me that no one would believe me, and that he would take the children from me. He was now a respected staff member in social services.

1999
After a horrendous Christmas and new year, I was trying to work out how I could leave. On returning to work I asked my boss at work for help, whose reply was “it can’t be that bad!” on the basis that he knew him. 

Whatever employer it is, managers should be trained to respond to disclosures of domestic abuse appropriately. This was an actual appeal for help, I went home for another couple of years.

2000
Another awful holiday at Christmas again. I walked out on New Year´s Eve. 

It was over.

The clues were there throughout those 20 years. I never recognised any of the above as abuse, until about a year after I left him.

________________________________________________________________________

‘Laura’ left school at 18, and worked in a bank until her first child was born. She returned to full time work in 1987 and worked for 30 years in various public sector roles. She graduated from the Open University in 2008, with a degree in Social Policy and Criminology. For the last 15 years she worked for a local authority, eventually as a Senior Manager responsible for domestic and sexual abuse services. She remarried in 2006, and has now retired from full time work so enjoys spending more time with her family especially her three grand-daughters.





Friday, 8 December 2017

VAW 2017: Violence for the Sake of Saving Family Honour is a Crime not a Culture

by Sadiq Bhanbhro
 

Honour has been a central concept across societies throughout history. It has been attributed as an underlying reason of horrible types of violence, for example, duelling in England, foot binding in China and wife burning (sati) in India.

Violence against women and girls in the name of defending supposed honour of an individual, family, clan or community is increasing in many parts of the world. Nearly 1100 women were killed in the name of honour in Pakistan; more than 1000 cases of honour killings reported in India and more than 11,000 incidents of honour crimes were recorded by United Kingdom police forces from 2010 to 2014.

Honour based violence or honour crimes are umbrella terms, which include a range of harmful practices committed using the pretext of honour such as: domestic abuse; violence or death threats; sexual and psychological abuse; acid attacks; forced marriage; forced suicide; forced abortion; female genital mutilation; assault; blackmail; marrying without consent and being held against one's will. Killing or attempted killing of a woman or a girl (mainly), a man or a boy (in some cases) in the name of saving or restoring honour of a family, clan or community (commonly known as honour killing) is an extreme form of honour based violence.

The term 'honour killing' has a long history but gained currency in late 1990s, as a label used within activism, research, and scholarship associated with the killing of women and girls, mainly in Muslim communities in their own countries and migrants in Europe and America. Since then, there has been much discussion and debate around the subject. In recent years, media, human rights groups and scholars including philosophers have marked honour crimes as a culturally specific category of violence, distinct from other prevalent types of violence against women such as domestic, intimate partner violence and crime of passion.

In the 'cultural explanation' of honour crimes, the culture and traditions of the particular communities are taken as causes of the criminal violence. Hence, the cultural classification not only stigmatise particular act of violence but entire culture of communities (Abu-Lughod, 2015). In addition, the term honour combined with violence and killings assumes that violence, in particular against women, is culturally sensitive—a sensitivity that allows the perpetrator to use further coercion to prevent the victim from seeking help and to intimidate the agencies of the state to stop them from pursuing and prosecuting these violent crimes.

The existing account of honour crimes have created hurdles to address this problem by making it a hypersensitive issue, stigmatising and stereotyping certain cultures, religions and regions and in western countries mainly black and ethnic minority groups (Bhanbhro, Chavez, & Lusambili, 2016). When honour related violence is dismissed as a cultural issue, communities in which it prevails are stigmatised (Ewing, 2008) and those who suffer violence also face their suffering being brushed off as a cultural problem. While, some scholars argue that it is necessary to be mindful while analysing and understating violence against women in cultural terms; as cultural understating and representation of violence conceal more pressing and central structures of violence affecting women and political processes that shape it; in those parts of world where usually culture is blamed for such violence (Abu-Lughod, 2011 & Shah, 2007).

This doesn't mean that the cultural has nothing to do with honour based violence, it does; but the cultural explanation masks the other wider social, political and economic structures and ideologies behind violence against women and girls. In fact, violence against women and girls is a widespread problem in all societies around the world – but its manifestations and extent differ widely according to place, time and context. For instance, recent census figures show 900 women were killed by men in six years in England and Wales. There is no cultural explanation behind these killings, but one thing is common in all sorts of violence against women and girls, and that is patriarchal mind-set. This is widespread and rooted in all layers across societies. Men have created self-serving tools to protect and promote this outdated patriarchal system. They have invented and formalised extremely restrictive codes of behaviour for females - gender based arrangements to restrict women's mobility, speech and sexuality, specific forms of family and kinship, perceptions and expectations for women's conduct. Above all a powerful ideology of honour has been tied to womenfolk, which is used as an excuse for honour killings. These all devices are created and managed by men to treat women as objects to use for their own purposes. Hence, if a woman's behaviour or action is seen to threaten the patriarchal order, she is ought to be punished and that punishment could be her murder.

Besides, a poor understanding of the context and narratives behind honour killings-such as social, religious, cultural and class structures- could contribute to unreliable assessments and analysis of the issue, in turn vague solutions could be suggested. Moreover, perspectives of the communities where honour killings believed to occur have been afforded less attention. Therefore, a public health approach to the issue could include creating a definition of the problem that is unprejudiced and inclusive. This is because if it is seen as problem that can affect anybody, rather than just one part of a community it will be treated more seriously by the police, judiciary, social and healthcare professionals.

 ______________________________________________________________________

References
Abu-Lughod, L. (2015). Do Muslim women need savings? London: Harvard University Press.

Bhanbhro, S., Chavez, A., & Lusambili, A. (2016). Honour based violence as a public health problem: critical review of literature. International journal of Human Rights in Healthcare 9:198 - 215.

Ewing, K. P. (2008). Stolen honour: Stigmatizing Muslim Men in Berlin. California: Stanford University Press.

Abu-Lughod, L. (2011). Seductions of the "honour crime". Differences 22:17-63.

Shah, N. (2007). Making of crime, customs and culture: the case of karo kari killings of upper Sindh. In Scratching the surface: democracy, traditions, gender. Bennett, J. eds. Pp. 135-154. Lahore: Heinrich Böll Foundation.

______________________________________________________________________

Sadiq Bhanbhro is a Research Fellow in Disparities and Global Perspectives in Health and Wellbeing at Sheffield Hallam University. He is a trained social anthropologist and a public health professional with research interests in social and political determinants of health including gender, sexuality and violence.

Thursday, 7 December 2017

VAW17: Hidden Mistreatment of marginalized older Pakistani women in the UK

by Ashfaque Talpur

While the mistreatment of older people has received little attention in academia and by the public, the well-researched area of domestic violence also lacks adequate acknowledgement of violence against older women. Evidence confirms that older women are twice as likely to face mistreatment than older men. In the UK, a prevalence survey of elder abuse and neglect reported that 3.8% of women experienced mistreatment compared to 1.1% of men in the past year. Unfortunately, there is no study on the prevalence of elder mistreatment specific to ethnic minority groups; however, many studies indicate that marginalised Pakistani older women are at highest risk of mistreatment.

Language, education, status in culture and religion, and acceptance in society are some of the many factors that increase the vulnerability of older Pakistani women to violence and mistreatment. Many Pakistani women, when they first arrived in the UK, accompanying their husband, came here as dependants with no or limited education and a mindset to run the household and raise the children. This is based on my PhD research study. Many of these young women, turned older today, voiced that their limited ability to speak English, having no formal education, and restrictions on the mobility sanctioned by their partners deprived them of the outside world and had left them as isolated and a very vulnerable person. Besides, there are many other factors that limited older Pakistani women from interacting and mingling with the host communities such as differences in culture, lifestyle, and Islamophobia in the society. For many older Pakistani women, however, it is not all about interacting and mingling with the host communities, it is the loss of the well-developed and close-knit social support network that they had in Pakistan, they feel uprooted of and they are missing it here in the UK. This isolation and loneliness is leaving many older Pakistani women marginalized and vulnerable to mistreatment.

When asked which gender is more likely to face mistreatment? The answer often was: ‘who is more likely to live longer’. Not only do women live longer, they are also likely to suffer from long-term health conditions contributing to their dependence and vulnerability. Many older Pakistan women are not only living longer, but are living alone too, and the death of their partner, depending on children or others, and limited exposure to the outside world adds to the challenges they face in day to day life. Many studies confirm a higher rate of violence and mistreatment against dependent and weak women, where the perpetrator is more likely the offspring. In addition, the stereotypes among health and social service provider, such as “they look after their own” and “myths of return” darkens the spotlight on them in the mainstream care provision.

Apart from the risk of vulnerabilities, the barriers in reporting, such as acceptance of violence, language, and family pressures leaves older vulnerable women with no options than to embrace the violence and mistreatment. This lays a huge responsibility on service providers, community members, researchers and policy makers to understand, explore, and intervene appropriately to address the issue and empower and strengthen the support for weakened and marginalised Pakistan older women.

_______________________________________________________________________________

Ashfaque Talpur is a 3rd year PhD student at the University of Sheffield. He is working on older mistreatment in Pakistani communities. He also holds a master degree in Public Health, from The University of Sheffield. Ashfaque is interested in academic research related to adult safeguarding, BME groups, health and wellbeing, and sexual health among young people.


Wednesday, 6 December 2017

VAW 2017: Masculinity: The Abuse of Sexuality Rights of Men and Teenage Boys with Learning Disabilities

by Edward Oloidi

This blog entry explores the impact that the gender of men and teenage boys with learning disability has on their sexuality rights. Literature explored highlighted the abuse of sexuality rights amongst men and teenage boys with learning disabilities linked to perception of masculinity. Suggestions are made for practice.

Research findings show that disabled persons are more susceptible to abuse compared with others in the society (Northway et al, 2013). Smith et al, (2011) highlighted issues of intimate partner abuse amongst disabled persons. Thus confirming that individuals with whom they are familiar are often behind the sexual abuse (Mind, 2007). The recent revelation by the BBC’s Victoria Derbyshire programme found a staggering 4,748 of sexual abuses were reportedly committed over two financial years (2013-14 and 2014-15) against disabled adults (BBC, 2015). Of this figure, 63% were committed against adults with learning disabilities (LD), perhaps an indication of the prevalence of sexual abuse amongst both men and women with LD. Despite the growing evidences on the risk of sexual abuse of disabled individuals (Mind, 2007), others often label disabled people as the perpetrators of sexual abuse (Ellison et al, 2015).

Perhaps underpinned by feminist ideology of female history (Hill, 2016) or traditional views of female gender inferiority (Young et al, 2012), females with LD are often seen as victims of sexual abuse and rape (Khalifeh et al, 2013). By contrast, males are characterised as perpetrators (Young et al, 2012). Societal norms of gender roles and attached behaviours appeared to prejudice views on acceptable experiences amongst individuals based on actual or perceived sex or sexuality (Green, 2008) – particularly men and teenage boys with LD. A masculine view of these individuals appeared to dominate perception of their sexuality rights (Wilson et al, 2011). Such masculinity appeared to prejudice views of sexual behaviours amongst men and boys with LD as predatory, aggressive and problematic (Young et al, 2012). Consequently, the conflicting dilemmas of perceptions held of LD as dependence and masculinity as independence constitute limitations to rights and sexual health amongst men and teenage boys with LD (Wilson et al, 2012).

The impact of this predicament manifests itself in studies linking men and teenage boys with LD to sexual abuse (Hays et al, 2007). In the past, attempts to deal with this perceived troubling situation has witnessed abuse of the sexuality rights and health of this population. This includes medical (Sajith et al, 2008), chemical and surgical (Carlson et al, 1997) sterilization of men and teenage boys with LD. Recently, Wilson et al (2011) identified measures such as the conditional representation of men and teenage boys’ sexuality rights. Underpinned by the social construct of masculinity, conditional sexuality represents socially motivated representation of sexuality rights particularly amongst men and teenage boys with complex LD (Wilson et al, 2011). This in turn dictates the level and quality of sexuality support (Jorrisen and Burkholder, 2013) provided to individuals – this signifies that the reported incorporation of masculinity theories in various studies on the lives of men and teenage boys with or without LD (Wilson et al, 2012) exclude sexual health needs of this population (Wilson, 2011). An indication that socially motivated ‘problem-led’ views of masculinity continue to present a dilemma to the recognition of sexual health and rights amongst men and teenage boys with LD (Wilson et al, 2011).

Several factors have been highlighted as major contributors to failure to detect, prevent and support the recovery from the trauma of sexual abuse by persons with LD. Central to this is health care professionals’ lack of knowledge of indicators of abuse (European Nursing Congress, 2003) which could potentially militate against practitioners’ responsibilities to identify and support abused individuals (Moss et al, 1997). Although knowledge of indicators of sexual abuse has been described as crucial to support (Sequeira, 2006), emphasising the need for education on sexual abuse amongst all care professionals involved with individuals LD. However, a shift towards better understanding on how to support sexual health and rights of individuals with LD will not only assist the development of a ‘healthy masculine sexuality’ (Wilson et al, 2011), it will prevent sexual abuse of individuals with LD in general.
 ____________________________________________________________________

Edward Oloidi is a third year PhD student currently working on a project entitled: ‘A mixed methods investigation into how perceived public perceptions regarding personal and sexual relationships of adults with intellectual disabilities might influence social care workers’ attitudes, beliefs and behaviours’ (Wales). Edward undertook a two-phase study involving critical incident technique driven qualitative interviews with 18 Social Care Workers (SCW) across community living services at phase one. Findings informed the development of quantitative surveys for exploration of larger views amongst SCWs at the phase two of the study.

Edward has previously worked as part of the local community learning disability team supporting adults with learning disabilities across community living services. Having completed a post-graduate certificate in health and social care professional education (PGCE) in 2013, Edward is a qualified teacher and a fellow of the Higher Education Academy.
 ____________________________________________________________________


References

Bradley, J. (2015) Sexual abuse of disabled adults revealed. London: BBC. [Online]. Available from: http://www.bbc.co.uk/news/uk-32693998

Ellison, L., Munro, V. E., Hohl, K., Wallang, P. (2015) Challenging criminal justice? Psychosocial disability and rape victimization. Journal of Criminology & Criminal Justice, 15(2) p. 225 – 244

European Nursing Congress (2003). Abuse going unnoticed due to lack of skills. Nursing Standard, 18 (5), 9, p. 15 – 21

Green, T. K. (2008). Discomfort at Work: Workplace Assimilation Demands and the Contact Hypothesis, 86 N.C. L. REV 379 396-97.

Hays, S. J., Murphy, G. H., Langdon, P. E., Rose, D., Reed, T. (2007). Group treatment for men with intellectual disability and sexually abusive behaviour: Service user views. Journal of Intellectual and Developmental Disability, 32, p. 106 – 116.

Hill, B. D. (2016). Sexual Admissions: An Intersectional Analysis of Certifications and Residency at Willowbrook State School (1950–1985). Journal of Sex and Disability, 34, p. 103–129

Jorissen, S. L., and Burkholder, G. J. (2013). New measures to assess attitudes and intended behaviours of paid caregivers towards sexuality of adults with developmental disabilities, Disability Studies Quarterly, pp. 1 – 21.

Khalifeh, H. et al. (2013) Violence against People with Disability in England and Wales: Findings from a National Cross-Sectional Survey. PLoS ONE8(2): e55952. https://doi.org/10.1371/journal.pone.0055952

Mind (2007) Another Assault. London: Mind.

Northway, R., Melsome, M., Flood, S., Bennett, D., Howarth, J., Thomas, B. (2013) How do people with intellectual disabilities view abuse and abusers? Journal of Intellectual Disabilities, 17(4), p. 361–375

Sajith, S.G., Morgan, C., Clarke, D. (2008). Pharmacological management of inappropriate sexual behaviours: a review of its evidence, rationale, and scope in relation to men with intellectual disabilities. Journal of Intellectual Disability Research, 52(12), p. 1078–1090

Sequeira, H. (2006). Implications for practice: research in to the effects of sexual abuse on adults with intellectual disabilities. Journal of Adult Protection, 8 (4), P. 25 – 31

Smith, K., Coleman K., Eder, S., Hall, P. (2011) Homicides, Firearm Offences and Intimate Violence 2009/10: Supplementary Volume 2 to Crime in England and Wales 2009/10. London: Home Office Statistics.

Wilson, N. J., Shuttleworth, R., Stancliffe, R., Parmenter, T. R. (2012). Masculinity Theory in Applied Research with Men and Boys with Intellectual Disability. Journal of Intellectual Disabilities, 50 (3), p. 261–272

Wilson, N. J., Parmenter, T. R., Stancliffe, R. J., and Shuttleworth, R. P. (2011) Conditionally Sexual: Men and Teenage Boys with Moderate to Profound Intellectual Disability, Journal of Sexualities and Disabilities, 29, pp. 275–289.

Young, R., Gore, N., McCarthy, M. (2012). Staff attitudes towards sexuality in relation to gender of people with intellectual disability: A qualitative study. Journal of Intellectual & Developmental Disability, 37(4), 343–347.




Tuesday, 5 December 2017

VAW17: Arts-based research and transitional stories of domestic violence

by Jamie Bird

The aspect of domestic violence and abuse (DVA) that I wish to discuss in this blog is to outline what I think is an important component of how people move away from violence and abuse towards a safer future that they have control of. The following thoughts are primarily based on doctoral research I conducted alongside women who had experienced domestic violence. Using an arts-based methodology I explored how imagination could be a way of understanding how women’s journeys’ away from violence were constructed. These stories indicate what was important for women and how the past, the present and the future fit together to form what I have termed ‘transitional stories’.

Starting with the relationship between the past, the present and the future, what the transitional stories showed was that the way in which women managed their past will influence their view of the future. This might be in terms of how ways in which they built resilience to survive living with violence and abuse can be re-employed to gain agency in the present after leaving. It might also emerge in how the idea of a good relationship and family still exists and can form the basis of hope for such things in the future. What I found to be really interesting was how the sense of an imaginary and fantasised family home or family seemed to survive experiences of domestic violence. So for example, the idyllic image of the cosy home with a pretty garden was something that existed before experiences of violence and abuse, and formed the basis for what women hoped to attain in the future. This notion of the idyllic, and very often imagined, past forming the basis for hopes for the future also extended to how women thought about important relationships and family connections. This led me to work of philosopher Susan Brison (2002), who has put forward the idea that for some aspects of life we imagine the past and remember the future. This is a counter-intuitive idea but makes sense when we start to consider how memory can be unpredictable and easily manipulated by later experiences, or shaped by cultural representations. In turn, ideas about the future are based on that imaginary past. In such cases the future has the flavour and shape of a memory. This is a helpful concept in terms of working with women who have experienced domestic violence and abuse to think through what they want in the future, and how that might be helped or hindered by what they imagine or remember.

Another interesting element of transitional stories is that everyday acts can come to symbolise agency and reclaiming control. This seems particularly relevant when considering how women represented the way in which they decorated their homes or prepared food or created a garden. Again, this was relevant in the present and in the future. Through these acts, abstract concepts such as agency and resistance start to have very real and embodied manifestations. Nature, for example, appeared to have strong associations with harmony and freedom, and so access to nature became important for the women who took part in the research. That might be through gardening, or it might be through going for walks in the countryside or visits to the coast.

By combining these various elements of memory, imagination and embodiment together it is possible to state that the management of the physical home becomes a manifestation for agency, resistance and the expression of a hope for a more harmonious life. To help make sense of these ideas the work of Venessa May (2011) and the concept of belonging proves to be very useful.

This work has been developed for publication (Bird, 2017) and my plans are to explore in greater detail how imagination and belonging shape the experiences of moving away from domestic violence abuse. This will involve working with a wider range of participants from different backgrounds and locations.

_________________________________________________________________________________

Jamie Bird is an HCPC-registered art therapist and an arts-based researcher based at the University of Derby, UK. Up until recently he was leading an academic department that delivered education and training in the fields of occupational therapy, counselling and psychotherapy, and the arts therapies. He now works solely within the research centre in the College of Health and Social Care at the University of Derby. His role involves developing his own research, helping others in the research centre and across the college to develop their research ideas, and assisting with the operational running of the research centre. The University of Derby aspires to enhance its REF output and all aspects of his role contribute to that vision. His personal areas of interest include issues of concern around asylum and refuge, domestic violence and abuse, and developing a quantitative evidence base for the arts therapies so as to help with the commissioning of arts therapies within health and social care. Much of his methodological experience has been centred on using the creative arts to engage the imagination of participants, researchers and audiences. In terms of philosophy, that methodology is founded upon the principles of phenomenology and the politics of emancipation and social action.


References

Bird, J. (2017) Bird, J. (2017) Art therapy, arts-based research and transitional stories of domestic violence and abuse. International Journal of Art Therapy

Brison, S. (2002). Aftermath: Violence and the remaking of the self. Princeton: Princeton University Press.

May, V. (2011) Self, Belonging and Social Change. Sociology, Vol.45, No.3, pp.363-378


Monday, 4 December 2017

VAW 2017: Supporting Black and Ethnic Minority Women and Girls on Issues of Domestic Violence

by Zlakha Ahmed MBE
The violence against women and girl’s strategy which was developed in 2010 has become an important national framework for responding to the multiple forms of violence women experience. It has transformed the criminal justice response and influenced that of health and education, placing prevention at the centre and recognising violence against women and girls as an equality issue. Violence against women and girls includes a range of violent and abusive behaviour, including:

  • Domestic Violence
  • Forced Marriage 
  • Dowry Abuse
  • Female Genital Mutilation/Cutting (female circumcision)
  • Honour Based Violence
  • Sexual Violence
  • Rape
  • Sexual Assault
  • Stalking and Harassment
 
 
The Government’s definition of domestic violence is: any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality (Home Office, 2016). This can encompass, but is not limited to, the following types of abuse:
 
  • Psychological
  • Physical
  • Sexual
  • Financial
  • Emotional
 
 
More recently, controlling behaviour has also been added to the list, which is defined as ‘a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour’ (Home Office, 2016). So too has coercive behaviour – that is, ‘an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.’ (Home Office, 2016). This definition, which is not a legal definition, includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.
Domestic violence can be the same as ‘honour based violence’ (HBV) if it is done to defend the honour of the family/community, or if the victim feels they cannot leave the abuser/s because they fear bringing shame and dishonour upon them. ‘Honour’-based violence or ‘honour’ crime is an act of violence explained by the abuser/s as being committed to protect or defend the ‘honour’ of the family/community. These crimes include:
 
  • Domestic and Sexual Violence
  • Forced Marriage
  • Sexual Harassment
  • Social rejection and other forms of controlling and abusive practices carried out by the extended family or community members

Women may experience HBV if they are accused of not conforming to traditional cultural and religious expectations, including, for example:
 
  • Wearing make-up or western clothing
  • Having a boyfriend or being seen alone with a male who is not a family member
  • Pregnant outside of marriage
  • Having a relationship with someone from a different religion or nationality
  • Rejecting a forced marriage
  • Rumours/being seen acting inappropriately

In HBV, the risks can be high as there may be abusers in the extended family or community networks who may be more organised in the harassment or abuse of women. Other people in the family or community may pressure the victim to return to abusive situations or fail to support them.
 
How can you help as a professional?
 
Health and social care practitioners can play a very important role in this regard and below are some suggestions:
 
  • Acknowledge that you recognise how difficult it can be to leave an abusive relationship, overcome cultural or religious pressures from family and community members, as well as concerns over your immigration status and access to support. 
  • Share that most statutory agencies will be able to provide independent interpreter and that a different interpreter can be requested if there is the fear that they will tell your family about you.


Share that that there are agencies that will be able to go through the legal options available, including criminal action against the abuser/s and civil or family court orders for protection. These agencies can also advise on:

  • Housing
  • Money issues
  • Health and mental health, including self-harm
  • Social care
  • Educational and children’s needs.
  • Reassure and reinforce the need for reaching out for help and support if feeling unsafe.
 
 
The above article has been produced by drawing on both the End the Violence against Women and girls coalition (EVAW) that Apna Haq is a member organisation of, and the document THREE STEPS TO ESCAPING VIOLENCE AGAINST WOMEN AND GIRLS A guide for black and minority ethnic (BME) women and children, that was produced in 2010 by a government department with Southall Black sisters.
____________________________________________________________________
 
Zlakha holds a Higher National Diploma in business studies, a Certificate in Education and a Postgraduate Diploma in youth and community. She was awarded an MBE for Services to Women’s Rights and Community Cohesion in 2016. 21 years ago she founded the Apna Haq organisation, an early intervention prevention organisation supporting Black and ethnic minority women and girls on issues of violence against women and girls.
Zlakha was selected as a panel member by NICE (National Institute of Clinical Excellence) to develop the national domestic violence standards for health and social care, which were launched in Feb 2013.
Zlakha is ardent in ensuring that issues faced by women in the community are brought to the attention of policy makers at local, regional, national and international level. Thus she has engaged with the Government Select committee on Islamic Shariah councils representing Muslim women’s survivors voices, the Truth Project looking at sexual violence, and is a member of the South Yorkshire Crown Prosecution Service’s domestic violence scrutiny panel.

Sunday, 3 December 2017

The stigma of obesity

Roger Watson, Editor-in-Chief

Obesity is often viewed as something where people lack the willpower to do the things that they need to avoid in order not to be obese. Where people hold this view then they will be negative about people with obesity and stigmatize them. This does nothing to help people with obesity as this article from the USA by Wu and Berry (2017) titled: 'Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review' and published in JAN showsThe aim of the study was to: 'summarize the associations between weight stigma and physiological and psychological health for individuals who are overweight or obese'.

According to the authors: '(w)eight stigma can be defined as individuals experiencing verbal or physical abuse secondary to being overweight or obese. Weight stigma has negative consequences for both physiological and psychological health.' The study on which the article is based found 33 other studies to review. Put simply, the results of these studies verify what is known - that stigmatizing people with obesity has 'adverse physiological and psychological outcomes' for people with obesity. In conclusion, the authors say: '(p)roviding regular and accessible weight stigma education to the public and clinical healthcare providers is necessary.'

You can listen to this as a podcast

Reference

Wu, Y.-K. and Berry, D. C. (2017), Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic reviewJ Adv Nurs. doi:10.1111/jan.13511


Saturday, 2 December 2017

VAW 2017: Exploring needs with men who experience domestic abuse

by Sarah Wallace

“Male victims”?

“You don’t get many of those around here do you?”

“Put it into perspective, we’ve had 100s of women and only 4 men in the last 12 months.”

These were some comments from peers and professionals when I introduced my research study topic. Surprise, confusion, uncertainty they had heard correctly: “men as victims?” Sometimes expressions told their own story. However, thankfully this was not the norm. From the beginning and through to the end of my study, I have received positive encouragement from supervisors, peers, professionals in the sector and audiences at conferences. Nonetheless, comments conveying disbelief and surprise served as a reminder that men experiencing domestic abuse are not easily recognised as victims of this very serious health and social issue.

So, “What about the men”?

In the United Kingdom, domestic abuse is largely recognised as affecting women. However, men experiencing domestic abuse is a substantial issue. Figures from the Crime Survey England and Wales (CSEW) indicates there are approximately 1.2 million female and 700,000 male victims (ONS, 2013). However, men are much less recognised. Research has traditionally focussed on male perpetrators and female victims (Graham-Kevan, 2007; Drijber et al, 2013). Despite a lack of research in this area (Hines & Douglas, 2010; Ansara & Hindin, 2011), the issue is gaining momentum and research is expanding (Zverina et al, 2011; Corbally, 2015). However, an in-depth qualitative understanding of men’s needs and their help-seeking experiences remains limited (Corbally 2015; Morgan et al, 2014).

Men experience a range of abuse (physical, financial, sexual, emotional and coercive control). Male victimisation is associated with poor health, alcohol and recreational drug use, physical injury and psychological harm including post-traumatic stress disorder (PTSD) and depression (Coker et al, 2002; Hines & Douglas, 2015). Men are less likely to seek support. Shame, social stigmatisation, notions of masculinity, denial and fears of humiliation, ridicule and not being believed are all barriers to preventing men from disclosing.

Knowledge of local existing services and referral pathways can help facilitate a safe enquiry and disclosure. Knowing that support is available is imperative; a lack of such can magnify feelings of isolation. Specialist support offers advocacy, safety, emotional support, practical guidance and the opportunity to recover. However, knowing help out there is not enough. The men in my study did seek out the support of a domestic abuse service directly. They required reassurance from others (mental health, welfare services, police and family) that accessing a domestic abuse provision was acceptable, that their experiences were serious and important enough to do so. The reassurance of others also meant that they were taken seriously, listened to and believed. This is important; being believed affords feelings of psychological strength (McCarrick et al, 2016). Nurses and other health professionals should be aware that anyone (irrespective of gender) can be a victim of domestic abuse. My study revealed very low numbers of referrals from health and mental health professionals for male victims into domestic abuse services. Nurses/health professionals may lack the confidence to enquire about domestic abuse to men, they might be uncertain how to respond, and they could be unsure of how or where to refer to. These are all very important concerns.

All these factors require consideration when thinking about how you as a nurse/health professional might enquire or manage a disclosure of abuse from a man. Without the knowledge and validation of those they had disclosed to, the men in my study would not have accessed the support they needed to recover.



References

Ansara, D. L., & Hindin, M. J. (2011). Psychosocial consequences of intimate partner violence for women and men in Canada. Journal of Interpersonal Violence, 26(8), 1628-1645.

Coker, A. L., Davis, K. E., Arias, I., Desai, S., Sanderson, M., Brandt, H. M., & Smith, P. H. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventative Medicine, 23(4), 260-268.

Corbally, M. (2015). Accounting for intimate partner violence: A biographical analysis of narrative strategies used by men experiencing IPV from their female partners. Journal of Interpersonal Violence, 30(17), 3112-3132.

Drijber, B. C., Reijnders, U. J. L., & Ceelen, M. (2013). Male victims of domestic violence. Journal of Family and Violence, 28(2), 173-178.

Graham-Kevan, N. (2007). The re-emergence of male victims. International Journal of Men’s Health, 6(1), 3-6.

Hines, D. A., & Douglas, E. M. (2015). Health problems of partner violence victims. American Journal of Preventative Medicine, 48(2), 136-144.

Hines, D. A., & Douglas, E. M. (2010a). A closer look at men who sustain intimate terrorism by women. Partner Abuse, 1(3), 286-313.

McCarrick, J., Davis-McCabe, C., & Hirst-Winthrop, S. (2016). Men’s experiences of the criminal justice system following female perpetrated intimate partner violence. Journal of Family Violence, 31(2), 203-213.

Morgan, K., Williamson, E., Hester, M., Jones, S., & Feder, G. (2014). Asking men about domestic violence and abuse in a family medicine context: Help seeking and views on the general practitioner role. Aggression and Violent Behaviour, 19(6), 637-642.

Office for National Statistics. (2013). Focus on violent crime and sexual offences 2012/13 Chapter 4: Intimate Personal Violence and Partner Abuse. Retrieved from http://www.ons.gov.uk/ons/dcp171776_352362.pdf.

Zverina, M., Stam, H., & Babins-Wagner, R. (2011). Managing victim status in group therapy for men: A discourse analysis. Journal of Interpersonal Violence, 26(14), 2834-2855.

______________________________________________________________________

Sarah Wallace has recently concluded a social care PhD entitled: An investigation into the needs of men experiencing domestic abuse and current service provision (Wales). Sarah interviewed abused men, and managers and practitioners of domestic abuse services and mapped domestic abuse and sexual violence services for men in Wales. Findings informed the development of a unique interactive service map.

Sarah has previously worked supporting men and women experiencing domestic abuse. In 2013, she secured Welsh Government funding to train as an Independent Domestic Violence Advisor (IDVA). Sarah is a member of the Domestic Violence Special Interest Group in the World Organisation for Colleges and Academies in Primary Care (WONCA), and is a trustee for the Mankind Initiative.



Friday, 1 December 2017

VAW 2017: Intimate Partner Violence and HIV

by Debbie Talbot 

Research has shown that Intimate Partner Violence (IPV) is associated with higher incidences of HIV acquisition through forced, often traumatic sex and reduced ability to negotiate condoms (Li, et al., 2014). A recent systematic review and meta analysis (Hatcher, et al., 2015) has shown that IPV in women living with HIV is associated with reduced use of anti-retroviral therapy and fewer instances of viral suppression.

With advances in anti-retroviral treatment, People Living with HIV (PLWHIV) can now live long, healthy, fulfilling lives when engaged in services and treatment. There are, however, many people who fail to engage in services and therefore remain off treatment, resulting in more rapid disease progression and increased risk of onward transmission (Curtis, et al., 2015). Globally, violence and fear of violence is a significant barrier to seeking services for HIV prevention and treatment (UNAIDS, 2014).

The diverse backgrounds of PLWHIV in the UK (Public Health England, 2017) bring a varied client group who have a multitude of complex social and cultural influences impacting on health beliefs and behaviours. Some may be from countries where they have faced extreme stigma and discrimination, in which negative attitudes of healthcare workers towards HIV, social norms, and police corruption may have prevented them from seeking help for IPV. PLWHIV who have suffered IPV may lack bargaining power and be economically dependent on their perpetrator. The fear of stigma and ostracism from their community may result in reduced ability to look after their sexual health and attend HIV services (UNAIDS, 2014).

IPV has been shown to influence behaviours such as hiding HIV status to avoid violent reaction and hiding medications. Depression and anxiety can cause intentional or non-intentional missing of medication or the stopping of treatment altogether. IPV also reduces access to friends, family and social support which can all promote good adherence (Hatcher, et al., 2016).

Facilitating safer disclosure of HIV status was highlighted in 2006 by the WHO (WHO, 2006) as leading to both individual and public health benefit – however, evidence of the success of disclosure programmes was evaluated by Kennedy, et al., (2015) and found inconclusive results. In addition to this, recent evidence from the PARTNER study (Rodger, 2016) shows that PLWHIV who have sustained undetectable levels of HIV virus in their blood cannot pass on HIV to sexual partners. It could therefore be argued that the focus should be on service engagement and adherence support rather than disclosure. The British HIV Association (BHIVA, 2017) highlight the need to maximise access to treatment and spread the "undetectable equals untransmittable" message in order to reduce stigma experienced by people whose sexual partners fear infection.

My experience as an HIV Nurse has seen many women and men who have disclosed previous or ongoing abusive intimate partner relationships. I have seen them struggle with attending appointments and adhering to anti-retroviral medication. It can be extremely difficult as a hospital-based Nurse to reach out and connect with these people. Phone calls often go unanswered, we may have been asked by the patient not to contact them by post, and sometimes they do not give permission for us to write to their GP.

The recent Kings Fund Report (Anderson, et al., 2017) into the Future of HIV Services in England highlights the importance of addressing social, psychological and emotional factors in HIV care and promotes the need to develop joined up integrated services, building closer partnerships with other health services, GPs and community organisations . They also note that many HIV testing services do not currently address social and cultural drivers of health behaviours. Peer support is also well recognised as contributing to personal wellbeing and improved clinical outcomes (BHIVA, 2013) and could be key in building a more accessible support network for victims of IPV living with HIV.

More research is needed to explore in depth the specific issues and barriers to accessing HIV services facing those men, women and transgender people living with HIV who have experienced IPV. With this evidence we will then be able to form recommendations to develop and implement individualised support processes and care pathways to allow victims of IPV living with HIV to access medical and support services, and adhere to treatment.

____________________________________________________________________

My name is Debbie Talbot and I work for Sheffield Teaching Hospitals NHS Trust as an HIV Nurse Practitioner across the departments of Infectious Diseases and Tropical Medicine and Sexual Health. The role has enabled me to gain experience and knowledge in the field of HIV and antiretroviral therapy, along with an in depth understanding of the complexities facing people living with the virus. Prior to this post, I worked as a Staff Nurse on the Infectious Diseases unit and for Sheffield Travel Health Clinic. I am also studying for the MSc in Advanced Nursing Studies at the University of Sheffield. I gained an interest in Intimate Partner Violence and the effect it has on people living with HIV through working with people who struggle to engage with the HIV service and adhere to Anti -retroviral Therapy. I am currently exploring how IPV affects engagement with HIV services and in the future hope to develop support processes to facilitate safer links to HIV clinics.


 __________________________________________________________________

References

Anderson, J. et al., 2017. The Future of HIV services in England shaping the response to changing needs, London: The Kings Fund.

BHIVA, 2013. Standards of Care for People Living with HIV. [Online] Available at: http://www.bhiva.org/standards-of-care-2013.aspx [Accessed October 21 2017].

BHIVA, 2017. BHIVA endorses Undetectable equals Untransmissable (U=U) consensus statement. [Online] Available at: http://www.bhiva.org/BHIVA-endorses-U-U-consensus-statement.aspx [Accessed 20 October 2017].

Curtis, H. et al., 2015. People with diagnosed HIV infection not attending for specialist clinical care: UK national review. [Online]  Available at: http://link.springer.com.eresources.shef.ac.uk/article/10.1186/s12879-015-1036-3 [Accessed March 5 2016].



Kennedy, C. et al., 2015. Safer disclosure of HIV serostatus for women living with HIV who experience or fear violence: a systematic review. [Online] Available at: http://jiasociety.org/index.php/jias/article/view/20292 [Accessed October 20 2017].

Li, Y. et al., 2014. Intimate Partner Violence and HIV infection among women: a systematic review and meta analysis. [Online] Available at: http://dx.doi.org/107448/IAS.17.1.18845 [Accessed October 22 2017].

Public Health England, 2017. HIV Annual Data Tables. [Online] Available at: https://www.gov.uk/government/statistics/hiv-annual-data-tables [Accessed October 20 2017].


UNAIDS, 2014. Women living with HIV speak out against violence. [Online]

Thursday, 30 November 2017

VAW 2017: Gender pressures on the female and male genders in Pakistan

by Saima Eman


While we all know that gender-based violence affects women more than men, it strange to think that the male gender can be adversely affected by the negative stereotypes held by their female counterparts in many countries. South Asia can be a very good example in this regard and I will use the example of Pakistan to describe my point further.

What I observe is that it is not easy for men to accompany their spouse and children to family parks in the evening because that time is confined to ladies and children. In schools, men may not be allowed to go inside and communicate with teachers on a daily basis. One might say that this is a manifestation of patriarchy and a way things are in a patriarchal society such as Pakistan’s, however, this also has an impact on males too, or at least on some men. Since women in Pakistan feel uncomfortable in the presence of men other than their relatives, women in dual roles involving outside work and household tasks face a lot of pressure. That pressure is culture-driven, whereby women are expected to perform their household duties no matter whether they are working women or not. I would also call this pressure, an indirect form of self-bestowed pressure, which seems to stem from the unfounded, culturally instilled androphobia in Pakistani women. As a consequence, women feel overwhelmed with multiple tasks and responsibilities. Husbands are generally overprotective of their wives to the extent that ladies are not allowed to stand outside the house gate until the car or the taxi has arrived. Women from middle and higher classes are not seen walking to the markets outside the housing society. There is no safe public transport. The movement of women is quite restricted due to an unsafe environment. By unsafe, I am referring to the pollution of attitudes (male and female staring and ogling, hostile traffic) and the pollution generated by the smog.

The government institutions work in a haphazard way. When a man enters the women’s university, the security guards follow him as if he is a criminal. Female university students are perceived as the property of their parents and guardians. The parents pay their tuition fees. They cannot leave the university without their guardians. If a female student manages to escape the university within the university term, the parents or guardians hold the university, the teachers and the staff accountable. The guardianship gets transferred from parents to husbands following marriage.

Men who have experienced the friendliness of women in other countries (where they may have worked or studied), feel intimidated by the female members of Pakistani society because they give the man a stern or angry look as if he is any ordinary Pakistani (stereotyping him as a male villain or a chauvinistic person). Such a man avoids gatherings, which are dominated by ladies. Women domestic helpers are usually very defensive towards men because men are traditionally aggressive. Most men are perceived as aggressive with a domineering attitude, obsessed with sexual fulfilment, disrespectful towards women and their desires to the extent of honour killings in extreme cases. Therefore, suspicious glares from women towards men and androphobia is justified to a certain extent. Since men are also aware of the nature of Pakistani men in Pakistan, they assume an overly protective role towards their wives, mothers and sisters. For example, they would not sit with their female relatives in the male-dominated areas of a restaurant, hospital or market place. Due to the gendered societal response, an open-minded man would be uncomfortable being a male in Pakistan, while a female is overburdened with different roles. I can give my own example here. I have to do so many things on my own because my husband cannot accompany me everywhere due to his gender. For example, I have to miss delivering lectures at my workplace to accompany my child’s school trip to the zoo. I have to be late to work because I have to attend a practice assembly to motivate my son to speak before the audience (fathers not allowed). There is an hour’s distance between my child’s school and my workplace. My husband could easily help me out because he is 5 minutes from the school (at home) and he is not at work at the children’s school time. However, due to the school rules based on societal attitudes (females comfortable with females and males with males), the fathers are not allowed and as a female in Pakistan, I have to suffer.

The typical orthodox Pakistani culture does not accept friendliness of the opposite sexes. Those who go against the culture are termed as ‘liberal’, ‘modern’ in a negative way. Since the society segregates the male and the female genders, generally female members of upper middle class families are not seen walking on the roads, bicycling, and in roles defined as masculine by the society. The gender roles are still stereotyped into masculine (outside work) and feminine roles (inside household work). Even though many Pakistani women are going for higher education and careers in Pakistan, their primary role is still considered to revolve around the house and children, but men are not expected to work or help out at home. Therefore, when a female member from an upper middle class is seen in masculine roles, she is not protected from ugly stares of the men. Surprisingly, even in a female-dominated area, the female is perceived as a victim if a male enters that area. The underlying eastern societal perception is that the female gender is weak and unable to protect herself and survive without a man (brother, father, son or husband only). Therefore, the men (other than brother, father, son or husband) are perceived to be the perpetrators, the villains, and the women are perceived as victims no matter whether women are performing the masculine chores or even if a single man enters the female-dominated area.

The unhealthy expectations on behalf of the female gender about the male gender due to a stereotypical negative image of the male gender in Pakistan, the female gender is victimising the female gender through an increase in the female share of the burden. This is just one facet of gender discrimination. Even in household politics and workplace politics the female is both the perpetrator and the victim in Pakistan. The mother-in-law, sister-in-law, daughter-in-law politics occurs at home (primarily around kitchen control and division of the household tasks) whereby the female is a perpetrator and a victim. The mother-in-law complains to her son about her daughter-in-law; the daughter-in-law complains to her husband about the mother-in-law. The female domestic helpers gossip about daughter-in-law to mother-in-law and vice-versa. At workplace the female clerical staff as opposed to the male clerical staff disrespects the female teachers. The female bosses create problems for female subordinates and vice versa. The power politics occurs in the form of psychological bullying, taunts, harsh words, etc., and the physical torture occurs in the form of extra duties, work burden, extraordinary inspection and accountability.

I think that both genders are equally victimised in Pakistani society. The difference, however, could be in the form of overburden and restriction (of movement, and performing male-stereotyped roles) for the female gender and under-burden/restriction (in performing female-stereotyped roles) for the male gender.


Saima Eman
Lecturer in Psychology
Lahore College for Women University, Pakistan

PhD Commonwealth Scholar
University of Sheffield, UK

President
Khan Bahadur Visionaries Welfare

Twitter: @SaimaEman1